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Women who experience sexual harassment or assault account for the majority of people who have PTSD.

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Hidden behind the #MeToo movement is a disturbing and largely unappreciated fact: Women far outnumber men suffering from post-traumatic stress disorder (PTSD), with sexual victimization the leading cause.

The reason, many researchers say, has to do with the numbers of victims and the nature of the offense. Gender differences in the way women and men process threats may also play a role, as does the newly understood corrosive nature of ongoing, chronic stressors, such as sexually based street or workplace harassment. Just as important is the frequently shrouded nature of sexual violence itself. Deeply personal, these attacks are so deeply violating that their effects can persist far beyond the actual incident.

Legions of #MeToo Victims

The problem itself is enormous. Among a nationally representative sample of about 2,000 adults polled by the nonprofit Stop Street Harassment (SSH) earlier this year, an estimated 81 percent of women said they had faced some form of sexual harassment during their lifetimes. More than half of them reported having been touched or groped against their will, while 27 percent had been directly assaulted. SSH founder and study author Holly Kearl, an expert on gender-based violence, characterizes this constant harassment, characterizes this constant harassment as a “pervasive problem that permeates all sectors of our lives.”

Most women have known the chilling effects of harassment firsthand. Many minimize threats by routinely altering their daily lives, from crossing a street to avoid catcalls to moving to a safer address. But a surprising number of women face genuine bodily harm.

But with an estimated two-thirds of rapes never reported, according to the Rape, Abuse & Incest National Network (RAINN), the true number of assaults is believed to be far greater. RAINN estimates that a sexual assault occurs in the United States every 98 seconds. Only 6 percent of the perpetrators of those attacks ever spend a day in jail — the lowest rate for any violent crime.

Victims themselves can be reluctant to share their stories for various reasons. They may assume the confrontation wasn’t “serious enough,” they may fear reprisal, they made hold back to avoid ridicule, or they want to avoid dealing with law enforcers who may doubt their stories, the Maryland Coalition explains. That all-too-frequent situation has a name: “re-victimization.”

That may explain why the nonprofit PTSD United estimates that 1 in 9 women in the United States, or slightly more than 11 percent, develop PTSD. That makes women about twice as likely as men to experience this acute stress response.

The Danger of Associating PTSD With War

PTSD afflicts almost 8 million American adults in any given year. First labeled “shell shock” among returning World War I veterans, the condition is described by the American Psychiatric Association as a disorder brought on by a traumatic event and characterized by re-experiencing or “flashback,” excessive anxiety, obsessive thought, avoidance, emotional numbing, and hyperarousal. Victims can develop stress-related physical symptoms, too.

The National Center for PTSD, a division of the U.S. Department of Veterans Affairs, notes that trauma-related neurochemical changes can heighten vulnerability to hypertension and atherosclerotic heart disease. Thyroid and hormonal imbalances, as well as infections and immunologic disorders, can increase among trauma victims.

Still, there’s little attention given to the link between PTSD and women. In a study published in June 2018 in the journal BMJ Open, Drexel University researchers examined The New York Times’ articles from 1980 to 2015 and found that about 6 percent of trauma coverage during that period mentioned sexual assault as a precipitating factor in PTSD. The authors concluded that PTSD coverage in the press “does not reflect the epidemiology of the disorder,” because it fails to point out that the condition’s effect is 13 times greater among civilian populations than among military ones. Those civilians are overwhelmingly female.

“The fact that most people consider PTSD a result of combat masks the truth; that interpersonal and intimate violence can be more devastating than war or natural disaster,” says Farris Tuma, MD, chief of the Traumatic Stress Research Program in the Division of Translational Research at the National Institute of Mental Health in Bethesda, Maryland. “These crimes,” Dr. Tuma adds, “fundamentally disrupt the victims’ entire worldview.” The assumption that PTSD is caused by war is additionally dangerous because many women fail to seek care because they don’t recognize their symptoms to be PTSD-related.

PTSD’s Quiet Victims

Karestan Koenen, PhD, a former Peace Corps volunteer, knows the tragic extent of that disruption. Now a professor of psychiatric epidemiology at the Harvard T.H. Chan School of Public Health in Boston, Dr. Koenen was working in Africa when she was brutally raped by a local man. Her anguish worsened when her superiors chastised her for “promiscuity” rather than offering comfort or seeking justice. Her assailant went free and Koenen, struggling with fear, pain, and shame, returned home, broken and depressed.

As the #MeToo movement’s newly vocal victims dramatically illustrated, women who “tell” are frequently greeted with skepticism at best, and punishment at worst. Former Navy enlistee Angel T. faced both after her drugging and rape by a fellow sailor. (She asked that we not use her full name because she fears her family’s reaction.)

“He invited me to a party with other people, but insisted that I first come to his room for a drink. It seemed harmless," she recalls. “But the next thing I knew, I woke up naked next to him in bed. I was too embarrassed to say I didn’t remember anything.”

Incensed, she reported the incident to her superiors. They reacted with scold, scorn, and shunning that was so extreme it brought an end to her dream of a military career. Angel says she was never able to explain to her father, a career military office, the real reason she abandoned the Navy. He, too, would find fault with her, she believes.

While friends and relatives remained ignorant of the incident, Angel suffered the agonizing consequences of PTSD on her own. She battled debilitating anxiety, overwhelming fear, and episodes of deep depression. She found treatment only after weathering a brief, violent marriage, several suicide attempts, and bouts of utter hopelessness.

“You compartmentalize; you pack it far, far away,” says Angel, now a social worker in Chicago. “I blamed myself. I cried alone. And then I moved on.”

As described on PsychCentral.com, an overstimulated or unopposed amygdala can remain hyperalert, overreacting to seemingly innocuous stimuli. In addition, the initial flood of the stress hormone glucocorticoid can impair the hippocampus’s memory consolidation process, leaving individuals in an ongoing state of vigilance that further wears the body down.

Undoing these “reptilian” or instinctive bodily reactions is the goal of the somatic experiencing (SE) trauma treatment pioneered by Peter A. Levine, PhD, a faculty member of the Santa Barbara Graduate Institute in California and founder of the Somatic Experiencing Training Institute, based in Lyons, Colorado. Dr. Levine holds doctorates in medical biophysics and psychology.

The approach assumes that trauma is stored somatically, in the body. The individual can only be freed from its effects — the fight, flight, freeze, and faint responses — by following a clinical protocol that resolves these fixated states through the gentle and gradual “unwinding” of self-protective motor responses. That process is believed to lead to the release of the thwarted survival energy bound in the body. Clients acquire increasing tolerance for difficult bodily sensations and suppressed emotions, until they achieve control.

The theory, formulated during Levine’s four decades in the fields of stress and trauma, is shared in his best-selling book, Waking the Tiger, as well as in related works. In targeting instinctive reactions that fall below the level of awareness, his theory represents a dramatic departure from traditional talk therapies.

“We presume that trauma is not stored in the neocortex or in the limbic system, but rather in the brain stem, the most reptilian area,” says Joshua Sylvae, PhD, a faculty member of the Somatic Experiencing Trauma Institute and a trained SE practitioner based in Portland, Oregon. “It’s not something that we think our way into, nor is it something determined by emotional processes. We need to access the deepest parts of the brain to get to it.”

SE can be combined with cognitive behavioral therapy (CBT) that targets the thoughts that follow a traumatic event, sometimes by having the patient “re-experience” the incident, and, more commonly, by working to alter thought patterns behind difficult behaviors. Patients are guided though the recognition, reinterpretation, and relabeling of their thoughts and emotional reactions to the event, often during short-term and goal-oriented sessions. Cognitive processing therapy, prolonged imaginal exposure, and eye movement desensitization (EMDR) all share the goal of substituting awareness and a new, more positive mental dialogue for damaging, negative self-talk.

“These therapies attempt to rewire the brain to undo the damage that trauma creates,” says Mark Sirkin, PhD, a clinical psychologist and professor at Mercy College in Dobbs Ferry, New York. Dr. Sirkin trains mental health practitioners who deal with a population where the overwhelming majority of PTSD patients are women who are victims of domestic abuse.

Mindfulness meditation and other forms of progressive relaxation are sometimes used, too, as are anti-depressive or anti-anxiety drugs, whether temporarily or longer term.

Vanguard Research

Researchers are also exploring the possibility of prevention. At the Karolinska Institute in Sweden, accident victims who played the computer game Tetris soon after an automobile crash later reported fewer future intrusive memories. Well-timed distraction, the scientists concluded, helped block the memory-encoding substances that inundate the brain after a trauma.

Some scientists see the potential for anti-PTSD drugs, including hydrocortisone, that may one day be able to short-circuit debilitating memories by undoing brain pathways paved during trauma. Others are examining substances that can coax damaged brain receptors, which retreat following extensive exposure to stress, back into action. Disabled receptors can contribute to the sense of detachment and numbing feelings that accompany PTSD.

Genetics also may offer promise. Charles Marmar, MD, head of psychiatry at NYU Langone Medical Center in New York City, worked with colleagues to study the link between resilience and the likelihood of developing symptoms of PTSD after a trauma. The researchers tested police and other first responders when they were cadets, assessing the amount of the stress hormone cortisol present upon awakening. They then compared the cortisol findings with the recruits’ experience of acute stress symptoms in response to trauma years later, when they were actively engaged in law enforcement.

The researchers’ findings: Those who had posted the largest increases in the stress hormone cortisol upon awakening years earlier suffered the worst stress symptoms following a traumatic event. The results, published in the journal Biological Psychiatry, suggested that there are biological underpinnings to PTSD that might help predict and treat the disorder in the future.

The Might of #MeToo

For Bea Hanson, the former principal deputy director of the U.S. Department of Justice Office on Violence, the largest dose of hope has come with the healing embrace of the #MeToo movement and its proponents. “As we have more discussion, even more victims will come forward,” says Hanson, who now heads New York City’s Domestic Violence Task Force.

Koenen and Angel are among the many women who serve as active role models for others, offering positive proof that sexual assault victims can find hope and meaning after trauma. “My experience was absolutely defining in terms of how I’m spending my life,” says Koenen, who decided to study psychology after her assault and, now at Harvard, leads cutting-edge research on PTSD and genetics. Angel, eager to help other avoid her pain, pursued a degree in mental health work and includes many women with PTSD among her client population. Both have seen their wisdom and experiences benefit others while starting them on the road towards their own new lives.

“What these women are doing for some people,” Sirkin says, “#MeToo accomplishes for many others by enabling them to re-story their experience without blame and shame. And that empowers them to live again."